What are the responsibilities and job description for the Denials Management Specialist position at 10 Driscoll Children's Hospital?
Where compassion meets innovation and technology and our employees are family. Thank you for your interest in joining our team! Please review the job information below. Job Title: Denials Management Specialist General Purpose of Job: Under direct supervision, the Denials Management Specialist will be the first contact in accounts and determine where they go next in the denial’s process/review. They will also assist with the Billing, Follow-Up, Collection, Root Causing, Recovery, and Reporting of assigned Insurance or Self-Pay claims. Applying a scientific approach, to include research and analysis, the Denials Management Specialist will also occasionally assist with the discovery of denials or denial trends and offer recommendations for solutions as a denial preventive. Essential Duties and Responsibilities: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or hospital administration as required. Review each account in que and determine appropriate next steps, then categorize denials for team to review and act on. Ability to scrub account and move account forward for proper adjudication. Able to read and understand an EOB. Identify process errors in the organizational system or teams and assist in creating ways to limit them from occurring. Maintains utmost level of confidentiality at all times. Adheres to hospital policies and procedures. Committed to professional development. Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines. Occasionally assist with the Billing, Follow-Up, Collection, Root Causing, Recovery, and Reporting of assigned Insurance or Self-Pay claims. Occasionally assist in filing appeals as appropriate to resolve payer denials and work with payers to monitor appeals in process. Occasionally assist with other team members in functions to ensure work queues are below set threshold. Consistently meet productivity and quality standards. Assure patient privacy and confidentiality as appropriate or required. Maintain professional relationships and convey relevant information to other members of the healthcare team, and within the facility. Other duties as assigned. Supervisory Responsibilities: Effectively administers performance management system including: developmental feedback goal setting assesses competency progressive discipline Strong knowledge of and effective in administering hospital policies and procedures. Responsible for sound management of human resources. Makes and implements decisions compatible with organizational goals. Maintains composure, effectiveness, and flexibility under pressure. Education and/or Experience: Associate's degree (A. A.) or equivalent from two-year college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience. Minimum of one year healthcare experience in a healthcare setting. Outstanding analytical ability and financial skills. Experience with denials preferred. Understanding of payers, and coding experience preferred. Working knowledge of managed care operations and practices preferred. Working knowledge of health system admitting, billing, and utilization review as well as physician office practices, physician credentialing and physician billing practices preferred. Effective communication, organization, and interpersonal skills essential. Work independently. Excellent oral and written communication skills. PC skills necessary with experience in Microsoft Office products, including PowerPoint. English Language Skills Until all children are well. Driscoll Children’s Hospital and its specialty centers, urgent care centers, and after-hours facility serve a vast area covering 31 South Texas counties. The hospital is a 191-bed tertiary care center offering 32 medical and 13 surgical specialties. Combined with our non-profit, community-based Health Plan, Driscoll Health System is an exceptional workplace for anyone with a big heart and a drive for success. Smiles, hugs and a soothing touch are as much a part of Driscoll’s approach to treating children as is its advanced medical treatments and technologies. The core values at Driscoll Heath System are: Compassion, Advocacy, Respect, Excellence, and Stewardship. These values are exemplified through every position - from treating the most critical patients hands-on, to maintaining a clean environment, to keeping the organization running from behind the scenes. We invite you to learn about Driscoll’s rich history and explore the laidback lifestyle South Texas has to offer.
